Montana Medicaid Spend Reconciliation

Every CMS-64 service category for FY2024, and how much of each appears in this claims dataset.

44%High coverage

These claims represent 43.8% of Montana’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

This state reports little or no comprehensive managed care, so a comparatively large share of its spending appears as claims. The remainder is capitation, supplemental and DSH payments, Medicare premiums for dual eligibles, drug rebates and administration — none of which are claim-level. See the full reconciliation.

Total Medicaid spending, FY2024

$2,369,609,304

CMS-64 Total Net Expenditures, as Montana filed it

Visible in claims

$1,037,148,816

43.8% of the program

Published per-enrollee spending

$918PMPM

CMS-64 total ÷ 215,053 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$2,190,188,643

Services paid as provider claims. Coverage below 100% typically means part of the category is delivered through managed care, or billed with codes this dataset does not carry.

Read the category rows as indicative, not exact. The state total above is a like-for-like comparison and is sound. Individual rows are not, because the two columns are attributed differently: claims are categorised by billing code, while the CMS-64 is categorised by the authority the state pays under. A home visit billed under a 1915(c) waiver and the same visit billed under the state plan carry identical codes, so this dataset cannot tell them apart while Montana books them on different lines. That is why some rows exceed 100% while their neighbours sit near zero — it reflects where the state books the spending, not a discrepancy in the amount.

Service category	CMS-64 (state total)	Seen in claims	Coverage
Hospital (Inpatient & Outpatient)	$549,404,898	$383,954	0%
Prescribed Drugs	$385,456,140	$3,209,035	1%
Home & Community-Based Services	$320,237,805	$747,307,979	233%
Nursing Facility	$182,872,779	$23,580,534	13%
Physician & Surgical	$155,902,455	$68,074,454	44%
Other Care Services	$117,204,922	$1,355,139	1%
FQHC & Rural Health Clinic	$82,911,678	$70	0%
Other Practitioners	$82,069,285	$0	0%
Dental	$49,603,117	$35,107,132	71%
Behavioral Health	$49,204,582	$97,020,533	197%
Targeted Case Management	$47,442,049	$18,952,594	40%
Home Health	$40,715,621	$3,729,052	9%
Screening & Preventive	$30,786,827	$2,906,210	9%
Laboratory & Radiology	$24,871,793	$10,232,402	41%
School-Based Services	$20,591,997	$0	0%
Therapy Services	$18,845,046	$9,289,593	49%
Clinic Services	$14,078,938	$0	0%
Non-Emergency Transportation	$5,135,464	$7,421,764	145%
Hospice	$4,112,410	$0	0%
DME & Supplies	$3,833,830	$8,546,867	223%
Intermediate Care Facility (IID)	$2,507,300	$0	0%
Family Planning	$2,399,707	$31,505	1%

Categories no claims dataset can see$179,420,661

These are real spending — they are simply not paid as claims to providers, so no claims-based analysis will ever contain them. This is the bulk of the difference between the two figures above.

Service category	CMS-64 (state total)
Supplemental & DSH Payments	$384,908,250
Medicare Premiums (Duals)	$58,995,486
Other CMS-64 Lines	$183,038
Managed Care Capitation	$154
Drug Rebates & Collections	-$264,666,267

The table adds up. The categories above sum to $2,369,609,304, which is Montana’s CMS-64 Total Net Expenditures for FY2024 exactly. Every line the state filed is accounted for in one of the two tables — nothing is dropped or double-counted.

Sources: CMS-64 net expenditures from the CMS MBES/CBES quarterly expenditure reports (FY2024); enrollment from the CMS Medicaid and CHIP applications, eligibility determinations and enrollment data; managed-care share from the CMS managed care enrollment reports. Claims figures are from the public T-MSIS provider extract. Methodology.